# My patient should go stick his head in a pig **URL:** \ **Category:** The BBQ Pit\ **Created:** [August 27, 2004, 2:30am UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724 "2004-08-27T02:30:34Z")\ **Posts on this page:** 15\ **Page:** 6
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 2, 2004, 6:11pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/101 "2004-09-02T18:11:01Z")
> [@Mtgman](#): > > **DSeid** is, IIRC, a Pediatrician. > > Enjoy, > Steven Hey, thanks for remembering me! On our side we’d go a slightly different route when this didn’t smell right, and think Munchhausen (or -by-proxy). Of course these patients (or their parents) would be thrilled to get the cystoscopy. ---
**Author:** ![chorpler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chorpler/32/2888_2.png) [@chorpler](https://boards.straightdope.com/u/chorpler)\ **Post date:** [September 2, 2004, 6:35pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/102 "2004-09-02T18:35:26Z")
> [@Qadgop the Mercotan](#): > > Yup. The State does not make it a priority to maintain an addiction. Least of all when the detox is not life-threatening. Uncomfortable as hell, but not life-threatening. Hell, they take alcoholics off alcohol too, in prison, forcing a detox on them. And _that_ procedure is far more life-threatening. Well, yeah, but it’s also pretty much necessary, because alcohol will kill you, while methadone is pretty benign by comparison. Man, the whole topic is pretty depressing. ---
**Author:** ![Tamerlane](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tamerlane/32/7602_2.png) [@Tamerlane](https://boards.straightdope.com/u/Tamerlane)\ **Post date:** [September 2, 2004, 8:19pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/103 "2004-09-02T20:19:57Z")
Yeah, a common dodge. I’m surprised you don’t see it more often in a prison. A friend of a friend is a fucked up junkie in South Carolina and he has pulled this scam multiple times, only in different ER’s. Goes into the ER complaining of flank pain, is asked to give a urine sample, goes in a pricks his finger to get a drop of blood, then I guess standard practice ( at least back then in SC ) was to give the “suffering” patient a shot ( morphine, perhaps - that’s what I got in the ER when they thought I had a perforated appendix ). At that point he wqaits until backs are turned and skedaddles before follow-up tests can be done. Pretty pathetic. Now I quite legitimately had blood in the urine a few weeks okay ( and mucho pain to boot ). No stone ever metamorphized ( might have been a necrotic papilla or something else hard to notice ) either physically or after CT-Scans and an IVP, though along the way I had an appendicitis scare and due to bungled communications with my urologist, a charming semi-self-inflicted kidney cancer scare. But the cause remains unproven ( though it was definitely kidney-related ). So I guess lack of an identifiable stone isn’t always an issue. Myself, I got vicodin. I hate vicodin. I get no high at all - just makes me feel vaguely crappy ( though it does help with the pain if you take it early enough ). Morphine, now - that was okay. I shoulda got morphine to abuse :). - Tamerlane ---
**Author:** ![vetbridge](https://avatars.discourse-cdn.com/v4/letter/v/b5e925/32.png) [@vetbridge](https://boards.straightdope.com/u/vetbridge)\ **Post date:** [September 2, 2004, 9:58pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/104 "2004-09-02T21:58:32Z")
> [@Qadgop the Mercotan](#): > > screwing the pooch because I wasn’t listening is another. Now you are getting into my field. I am surprised how many of my clients try to scam drugs from me (I am a veterinarian). Mostly it is anabolic 'roids. I feel insulted when Mr Hulk walks in wearing a wife beater with _Gold’s Gym_ stamped on the chest and tries to get me to dispense stanozolol for his dog. But the fact that legitimate need is often overlooked is sad. When I had my cholecystectomy (with complications and a JP drain) my doctor released me with acetaminophen for pain. Only when I told him I would get a ride to the corner of Gin and Vermouth and buy something illicit did he break down and script a narcotic. ---
**Author:** ![Jake](https://avatars.discourse-cdn.com/v4/letter/j/f475e1/32.png) [@Jake](https://boards.straightdope.com/u/Jake)\ **Post date:** [September 2, 2004, 10:11pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/105 "2004-09-02T22:11:41Z")
> [@roger thornhill](#): > > I was referring to the fact that after I’d read Qad’s story I didn’t understand how the prisoner’s scam had worked prior to Qad exposing it, because Qad didn’t tell us. I thought this might be a symptom of an underlying trait in the profession when another doctor wrote something I couldn’t make head or tail of. > > Hence elliptical, as in an elliptical, indirect, implicit conversational style. Just brought out the discourse analyst in me, I guess. Thanks, Roger, I wasn’t clear on that post either. ---
**Author:** ![roger\_thornhill](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@roger\_thornhill](https://boards.straightdope.com/u/roger_thornhill)\ **Post date:** [September 3, 2004, 2:12am UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/106 "2004-09-03T02:12:09Z")
**Jake** , I guess I’ve just lived a sheltered existence! ---
**Author:** ![GingerOfTheNorth](https://avatars.discourse-cdn.com/v4/letter/g/cdc98d/32.png) [@GingerOfTheNorth](https://boards.straightdope.com/u/GingerOfTheNorth)\ **Post date:** [September 3, 2004, 12:50pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/107 "2004-09-03T12:50:16Z")
> [@vetbridge](#): > > When I had my cholecystectomy (with complications and a JP drain) my doctor released me with acetaminophen for pain. Only when I told him I would get a ride to the corner of Gin and Vermouth and buy something illicit did he break down and script a narcotic. All I had after mine was Tylenol. With a little shot of codeine included - T3s. ---
**Author:** ![vetbridge](https://avatars.discourse-cdn.com/v4/letter/v/b5e925/32.png) [@vetbridge](https://boards.straightdope.com/u/vetbridge)\ **Post date:** [September 3, 2004, 3:36pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/108 "2004-09-03T15:36:52Z")
> [@GingerOfTheNorth](#): > > All I had after mine was Tylenol. With a little shot of codeine included - T3s. Lemme esplain, rather than be thought a wimp. I was taken to the hospital by ambulance after 36 hours of severe pain (9.5/10). I knew it was my gallbladder, but was hoping to ignore it long enough to avoid surgery. I was icteric. After being started on IV antibiotics and fluids my lab values were going south. I was rushed to the OR where my surgeon expected to spend an hour removing my gallbladder. Four hours later he finished. I was taken from recovery to ICU due to some concerns over interoperative ECG findings which it turns out were spurious. I was released from the hospital a few days later, still on fluids only by mouth. One of my nurses resigned, telling me that she was sick of seeing people dischaged before they were stable just because their insurance expected them to be discharged. She told me this as she helped me dress. When my doctor walked in on the conversation he asked her to get out. My insurance paid for everything except for phone and TV, so I am not complaining. Walking from my wheelchair to the waiting car I nearly collapsed. I believe narcotics were indicated for the post op pain I was experiencing. 😉 ---
**Author:** ![chorpler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chorpler/32/2888_2.png) [@chorpler](https://boards.straightdope.com/u/chorpler)\ **Post date:** [September 4, 2004, 3:14pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/109 "2004-09-04T15:14:34Z")
> [@Qadgop the Mercotan](#): > > Anyway, I’m not a big fan of methadone maintenance anyway. And I am _not_ unknowledgeable in the field of Addiction Medicine. So I don’t have a problem with it. I take my time, and have even spent 3 or 4 months detoxing some of these guys who came in on 160 mg of methadone a day, slowly reducing their dose of alternate opiates by about 5% a week. I’m of two minds about the whole thing. On the one hand, it is undoubtedly often recommended or used by people who don’t really need it, and who frankly really don’t understand what they’re getting into – the original theory methadone maintenance was designed for was that the brains of long-term opioid addicts are permanently modified by the use of the drug, and I have a hard time believing that has happened for a person who has been taking painkillers for a few months. On the other hand, I think that a large number of the addicts I’ve interviewed probably had something wrong with their brain beforehand – probably 80% at least said they suffered from depression before they were addicts. And I’m glad that methadone maintenance is available for the people who need it. Especially the people who really are in pain but who can’t find doctors who will help them (as opposed to the ones who are pulling on hangnails to produce factitious hematuria, of course), although methadone maintenance is far from optimal for them – a once-daily dose is the best way to make use of methadone’s pain-relieving properties, as the pain relief wears off within 8 hours. Still, it’s better than nothing, and with the recently relaxed rules, the patients can get take-home doses pretty quickly, and can split up their take-home doses so they can switch from once-daily dosing to three smaller doses daily, or whatever. Hmmm … looking over some of my notes, I see that quite a few of the people I’ve interviewed who weren’t on heroin originally got on the methadone program because they were on painkillers for a relatively short period of time, and when they were taken off, they started taking painkillers from sick relatives, or injuring themselves and going doctor shopping like your patient, or ripping off doctors’ offices and forging prescriptions … in general doing anything necessary to keep their opioid receptors plugged. I know that addiction is extremely rare when painkillers are properly prescribed and used, but for those who are susceptible and who will do anything to get more, I’d rather there be a methadone program available for them to do it legally and above-board, and hopefully get some therapy while they’re at it (although the counselors at methadone programs I’ve been to have been pretty apathetic and useless, with a few shining-star exceptions). Ah well … as I said, it’s all fairly depressing. I like your therapeutic community idea … it would sure be nice if that came about. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 4, 2004, 3:48pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/110 "2004-09-04T15:48:28Z")
I appreciate your comments, **chorpler**. You obviously have experience in the area. But frankly, opiate addiction is _not_ just an endorphin deficiency. It is multifaceted, and needs to be treated on a lot of levels. But real treatment of the multiple facets requires the patient to be opiate free. Otherwise they can’t engage in treatment. To me, methadone maintenance is an approach where we are saying to the patient “we will settle for something less. Take this, and go do no harm. Or as little harm as possible”. IMHO, that individual will never reach anything close to their potential. Not intellectually, emotionally, or spiritually. So to use such an approach on individuals who were not repeatedly _in extremis_ from their addiction is abhorrant to me. I knew a woman who had 4 years of clean time, using the mutual help groups like NA and others. She relapsed on her drug of choice, oxycodone, for a few months. Her treating doc decided that she’d shown she could not stay clean, so put her on methadone, with the plan for her to be on it for life! _Relapse is in the nature of the disease, for crying out loud!_ I was appalled. She has since struggled to get off of methadone, with limited success. QtM hopeless opiate addict for 6 years, clean for over 14 years now. ODAAT. ---
**Author:** ![chorpler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chorpler/32/2888_2.png) [@chorpler](https://boards.straightdope.com/u/chorpler)\ **Post date:** [September 4, 2004, 7:20pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/111 "2004-09-04T19:20:43Z")
> [@Qadgop the Mercotan](#): > > I appreciate your comments, **chorpler**. You obviously have experience in the area. But frankly, opiate addiction is _not_ just an endorphin deficiency. It is multifaceted, and needs to be treated on a lot of levels. I agree – I don’t think it’s nearly as simple as “endorphin deficiency.” But still, I tend to think it’s _something_ (or multiple somethings, probably) – people who are depressed do seem to be more susceptible to becoming addicts, for one thing. And, contrary to the stuff I’ve heard/read about addicts having “addictive personalities,” or the things I’ve read about addicts being able to switch from opioids to amphetamines to levodopa to whatever as long as it’s a pleasurable drug, many if not most of the people I talk to claim that the only drug(s) that they really enjoy are opioids. I’ve heard some variant of this quite frequently: “Oh, sure, I’ll take cocaine or amphetamines if I need to stay awake for something, but it just doesn’t make me _feel_ good like (opioid of choice) does.” [sup]1[/sup] So, while it is no doubt not true for all the addicts, I tend to feel that _something_ was wrong with the brains of many of them beforehand. Not that I disagree with what you’re saying – obviously, until we can go in with nanobots or something and fix whatever is going on in the brain of an addict, multifaceted treatment of all the various levels is what works best. > [@](#): > > But real treatment of the multiple facets requires the patient to be opiate free. Otherwise they can’t engage in treatment. To me, methadone maintenance is an approach where we are saying to the patient “we will settle for something less. Take this, and go do no harm. Or as little harm as possible”. IMHO, that individual will never reach anything close to their potential. Not intellectually, emotionally, or spiritually. So to use such an approach on individuals who were not repeatedly _in extremis_ from their addiction is abhorrant to me. In my experience, methadone maintenance (at least when used on addicts and not pain-sufferers-in-disguise[sup]2[/sup]) is pretty much just what you say, something best used by people who can’t yet, or won’t yet, give up opioid use. I don’t know about it limiting their potential intellectually, emotionally, or spiritually – obviously many of the people I’ve seen at methadone programs have had their lives messed up for a while, and aren’t looking like shining stars at anything intellectual or emotional or spiritual. But I don’t know how much of that, if any, is attributable to the methadone they’re currently taking. Certainly there seem to be some people who don’t seem to be negatively affected at all by it, but that’s not saying much. I think people ought to be told when they sign up for a methadone program that whatever benefit they feel opioids are giving them, it doesn’t take very long for your brain to completely readjust, and then you’ll have to continue taking the methadone just to avoid feeling terrible, even though they won’t be giving you any good feelings at all. I think the reason people aren’t told this is that the people running the methadone programs usually assume their clients are already at that state. Which, in many cases, it seems they’re not. > [@](#): > > I knew a woman who had 4 years of clean time, using the mutual help groups like NA and others. She relapsed on her drug of choice, oxycodone, for a few months. Her treating doc decided that she’d shown she could not stay clean, so put her on methadone, with the plan for her to be on it for life! _Relapse is in the nature of the disease, for crying out loud!_ I was appalled. She has since struggled to get off of methadone, with limited success. That’s pretty appalling, all right, especially if the woman _wanted_ to stay clean and her doctor just gave up on her. Sigh. As I said before, it’s a depressing topic. > [@](#): > > QtM > hopeless opiate addict for 6 years, > clean for over 14 years now. > ODAAT. Wow, that’s quite an accomplishment. Good job, man. Let me ask you a question, if you don’t mind. In your experience, if somebody stops taking their daily methadone dose of 80 to 100mg cold-turkey, how long will it take for withdrawal symptoms to set in, and how long will they last? Is there any standard that can be expected? Most of the people I interview don’t go through withdrawal in the time I know them, so my experience is limited here. And one of my friends from a local clinic is thinking about stopping abruptly. * * * [sup]1[/sup]Or there are people like my grandpa and my uncle, who get no euphoric response at all from opioids – or who in fact get a dysphoric reaction or throw up violently, like **Dragonblink** reported in that post above – but who feel reeeeeeeeeeeally good when they drink alcohol. Ah, neurology, full of bizarreness. [sup]2[/sup]The pain patients I’ve met have often been noticeably different from the addicts, to the point that I can often spot them in a crowd at a clinic. They’re often dressed better and smell better, for one thing. Also, usually they’re better employed, and have fewer encounters with the criminal justice system. If their pain stops due to a new surgical technique or something, they almost always stop coming to the clinic – in followup interviews post-cessation, I found several of them who said they had stopped taking their methadone immediately after the pain stopped, and never experienced any real withdrawal symptoms (well, except diarrhea, which is almost universal in my experience, and some hot flashes or chills – virtually nothing compared to normal opioid withdrawal symptoms) despite multiple years on 60-110mg of methadone daily. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 4, 2004, 7:48pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/112 "2004-09-04T19:48:20Z")
> [@chorpler](#): > > I agree – I don’t think it’s nearly as simple as “endorphin deficiency.” But still, I tend to think it’s _something_ (or multiple somethings, probably) – people who are depressed do seem to be more susceptible to becoming addicts, for one thing. Or people who are addicts are more susceptible to depression. > [@](#): > > So, while it is no doubt not true for all the addicts, I tend to feel that _something_ was wrong with the brains of many of them beforehand. Sometimes there was significant dysphoria or dysfunction before drugs were ever started. But often addicts reported doing just fine until that first moment with their drug of choice, often opiates or cocaine. Then I suspect a molecular switch gets thrown, genes which were previously unexpressed get turned on, and neurochemistry is altered to produce an unnatural craving for the drug. > [@](#): > > Certainly there seem to be some people who don’t seem to be negatively affected at all by it, but that’s not saying much. IMHO, those on methadone for chronic pain don’t seem to suffer from the negative effects of chronic use. Probably because they never experienced much of the euphoria or the compulsion to use the drug that is the hallmark of the addict. > [@](#): > > I think people ought to be told when they sign up for a methadone program that whatever benefit they feel opioids are giving them, it doesn’t take very long for your brain to completely readjust, and then you’ll have to continue taking the methadone just to avoid feeling terrible, even though they won’t be giving you any good feelings at all. Yuppers! 😃 > [@](#): > > Wow, that’s quite an accomplishment . Thanks, but it had really come down to 3 options for me by the end. Madness, death, or recovery. What amazes me is how many addicts will still opt for madness or death. > [@](#): > > Let me ask you a question, if you don’t mind. In your experience, if somebody stops taking their daily methadone dose of 80 to 100mg cold-turkey, how long will it take for withdrawal symptoms to set in, and how long will they last? Is there any standard that can be expected? Symptoms of _methadone_ withdrawal will probably start within 24 to 48 hours, and frankly can last as long as 2 to 3 months. True opiate addicts will _suffer_ the most from the withdrawal. Those who are just physiologically dependent but not psychologically addicted will be at least a bit uncomfortable, and will not enjoy the experience, but seem to tolerate the process far, far better than those who live to use and use to live. These former individuals are the ones who also generally feel fine in 2 to 4 weeks or even less. ---
**Author:** ![Typo\_Negative](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/typo_negative/32/484_2.png) [@Typo\_Negative](https://boards.straightdope.com/u/Typo_Negative)\ **Post date:** [September 5, 2004, 8:23am UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/113 "2004-09-05T08:23:01Z")
> [@Qadgop the Mercotan](#): > > Or people who are addicts are more susceptible to depression. There do seem to be a lot of people in recovery who are being treated for depression. Many don’t seek treatment till after they have been clean for a couple of years. It’s a bit controversial in the program. Taking medication, that is. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 5, 2004, 1:18pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/114 "2004-09-05T13:18:02Z")
> [@spooje](#): > > It’s a bit controversial in the program. Taking medication, that is. It’s not controversial in the circles I move in. Nor should it be. Too many Dual Diagnosis people just won’t get well if their other illnesses are not treated. Bill W. would have loved to have SSRIs available back in the late 40’s and early 50’s when he was sober but suffering from a crippling, long-term depression. His writings at the time clearly stated he longed for the science of medicine to be able to do something for his depressive disorder. And he did try LSD (at the time a new pharmaceutical developed by Sandoz, and tested on people with depression) in an effort get well from that. ---
**Author:** ![chorpler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chorpler/32/2888_2.png) [@chorpler](https://boards.straightdope.com/u/chorpler)\ **Post date:** [September 5, 2004, 6:34pm UTC](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724/115 "2004-09-05T18:34:14Z")
> [@Qadgop the Mercotan](#): > > Or people who are addicts are more susceptible to depression. I don’t doubt it – not only are you fiddling with brain chemistry, but there are a lot of things in an addict’s life that would depress anybody. I was referring more to people who were depressed before becoming addicts, though, who are quite abundant in my experience. > [@](#): > > Sometimes there was significant dysphoria or dysfunction before drugs were ever started. But often addicts reported doing just fine until that first moment with their drug of choice, often opiates or cocaine. Then I suspect a molecular switch gets thrown, genes which were previously unexpressed get turned on, and neurochemistry is altered to produce an unnatural craving for the drug. Quite probable. On the other hand, a lot of people who are suffering from something less than major depression don’t realize it until they are put on antidepressants and realize how much better they feel. So I suppose it’s possible that a lot of addicts who reported doing just fine could have been suffering from depression and not have known it. Not major depression, obviously, but … anyway, I’m sure that there are also plenty of people where it happens like you say above, too. I guess there’s no way to know for sure how most addicts start out without a massive study. Anybody want to send me and Qadgop some funding? 🙂 > [@](#): > > IMHO, those on methadone for chronic pain don’t seem to suffer from the negative effects of chronic use. Probably because they never experienced much of the euphoria or the compulsion to use the drug that is the hallmark of the addict. That coincides quite well with my data. > [@](#): > > Symptoms of _methadone_ withdrawal will probably start within 24 to 48 hours, and frankly can last as long as 2 to 3 months. True opiate addicts will _suffer_ the most from the withdrawal. Those who are just physiologically dependent but not psychologically addicted will be at least a bit uncomfortable, and will not enjoy the experience, but seem to tolerate the process far, far better than those who live to use and use to live. These former individuals are the ones who also generally feel fine in 2 to 4 weeks or even less. Okay – he has already gone like 84 hours with no really troubling symptoms, so I wondered (and still wonder) if he isn’t going to, or if the symptoms are just taking a long time to show up. I found out his precise dose, too – 90mg daily, for the past four years. [Previous page](https://boards.straightdope.com/t/my-patient-should-go-stick-his-head-in-a-pig/261724.md?page=5)